The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand
Abstract Background Breast cancer is a major health concern worldwide, and Ki-67 level index is a prognostic factor that indicates tumor proliferation and predicts survival outcomes. However, the standard Ki 67 cut-off level varies between local laboratories, and in Thailand, there is no established...
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BMC
2025-02-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-025-13724-w |
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| author | Phanchaporn Wongmaneerung Imjai Chitapanarux Patrinee Traisathit Sukon Prasitwattanaseree Wisanu Rottuntikarn Areewan Somwangprasert Chagkrit Ditsatham Kirati Watcharachan Pitchayaponne Klunklin Wimrak Onchan |
| author_facet | Phanchaporn Wongmaneerung Imjai Chitapanarux Patrinee Traisathit Sukon Prasitwattanaseree Wisanu Rottuntikarn Areewan Somwangprasert Chagkrit Ditsatham Kirati Watcharachan Pitchayaponne Klunklin Wimrak Onchan |
| author_sort | Phanchaporn Wongmaneerung |
| collection | DOAJ |
| description | Abstract Background Breast cancer is a major health concern worldwide, and Ki-67 level index is a prognostic factor that indicates tumor proliferation and predicts survival outcomes. However, the standard Ki 67 cut-off level varies between local laboratories, and in Thailand, there is no established optimal cut-off level. Objective This study aimed to determine the optimal cut-off point for Ki-67 expression and investigate the association between Ki-67 levels and other prognostic factors with 8-year overall survival. Method A retrospective review of Ki-67 levels was conducted in non-metastatic breast cancer patients treated at Maharaj Nakorn Chiangmai hospital from January 2013-December 2015, including 507 breast cancer patients. Results The ROC curve analysis identified the optimal Ki-67 cut-point as ≥ 30%, with 75% sensitivity and 48.85% specificity. Age over 60 was associated with higher mortality regardless of cancer stage. Locally advanced staging, nodal involvement, Ki-67 ≥ 30%, and triple-negative subtype correlated with poorer survival. Even after adjustments, these factors remained significant in prognostic evaluation. Chemotherapy notably improved survival, especially in high Ki-67 (≥ 30) patients. However, this effect was not seen in low Ki-67 patients. High Ki-67 patients receiving chemotherapy showed improved survival in early-stage, node-negative cases compared to those who did not receive chemotherapy. HER2-positive patients with high Ki-67 benefited from chemotherapy, but statistical significance was not reached in hormone-positive patients. Conclusion This study identified the optimal cut point for Ki-67 in Northern Thailand as 30%. Patients with KI-67 above 30% show significantly lower 8-year survival rates. This is especially relevant for low-risk patients, like those with hormonal subtypes or early-stage nodal negativity. In these cases, KI-67 becomes crucial for treatment decisions. Our study not only aids Northern Thailand’s understanding but also aligns with broader research, emphasizing KI-67’s vital role in planning treatment for low-risk breast cancer patients. |
| format | Article |
| id | doaj-art-1eca2bbb70b34758a33e16efd94f6d5d |
| institution | DOAJ |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj-art-1eca2bbb70b34758a33e16efd94f6d5d2025-08-20T02:59:32ZengBMCBMC Cancer1471-24072025-02-0125111110.1186/s12885-025-13724-wThe association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern ThailandPhanchaporn Wongmaneerung0Imjai Chitapanarux1Patrinee Traisathit2Sukon Prasitwattanaseree3Wisanu Rottuntikarn4Areewan Somwangprasert5Chagkrit Ditsatham6Kirati Watcharachan7Pitchayaponne Klunklin8Wimrak Onchan9Division of Head Neck Breast, Department of Surgery, Chiang Mai UniversityNorthern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of medicine, Chiang Mai UniversityData Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai UniversityData Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai UniversityDepartment of Pathology, Chiang Mai UniversityDivision of Head Neck Breast, Department of Surgery, Chiang Mai UniversityDivision of Head Neck Breast, Department of Surgery, Chiang Mai UniversityDivision of Head Neck Breast, Department of Surgery, Chiang Mai UniversityDivision of Radiation Oncology, Department of Radiology, Chiang Mai UniversityNorthern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of medicine, Chiang Mai UniversityAbstract Background Breast cancer is a major health concern worldwide, and Ki-67 level index is a prognostic factor that indicates tumor proliferation and predicts survival outcomes. However, the standard Ki 67 cut-off level varies between local laboratories, and in Thailand, there is no established optimal cut-off level. Objective This study aimed to determine the optimal cut-off point for Ki-67 expression and investigate the association between Ki-67 levels and other prognostic factors with 8-year overall survival. Method A retrospective review of Ki-67 levels was conducted in non-metastatic breast cancer patients treated at Maharaj Nakorn Chiangmai hospital from January 2013-December 2015, including 507 breast cancer patients. Results The ROC curve analysis identified the optimal Ki-67 cut-point as ≥ 30%, with 75% sensitivity and 48.85% specificity. Age over 60 was associated with higher mortality regardless of cancer stage. Locally advanced staging, nodal involvement, Ki-67 ≥ 30%, and triple-negative subtype correlated with poorer survival. Even after adjustments, these factors remained significant in prognostic evaluation. Chemotherapy notably improved survival, especially in high Ki-67 (≥ 30) patients. However, this effect was not seen in low Ki-67 patients. High Ki-67 patients receiving chemotherapy showed improved survival in early-stage, node-negative cases compared to those who did not receive chemotherapy. HER2-positive patients with high Ki-67 benefited from chemotherapy, but statistical significance was not reached in hormone-positive patients. Conclusion This study identified the optimal cut point for Ki-67 in Northern Thailand as 30%. Patients with KI-67 above 30% show significantly lower 8-year survival rates. This is especially relevant for low-risk patients, like those with hormonal subtypes or early-stage nodal negativity. In these cases, KI-67 becomes crucial for treatment decisions. Our study not only aids Northern Thailand’s understanding but also aligns with broader research, emphasizing KI-67’s vital role in planning treatment for low-risk breast cancer patients.https://doi.org/10.1186/s12885-025-13724-wBreast cancerKi-67Cut-offSubtype |
| spellingShingle | Phanchaporn Wongmaneerung Imjai Chitapanarux Patrinee Traisathit Sukon Prasitwattanaseree Wisanu Rottuntikarn Areewan Somwangprasert Chagkrit Ditsatham Kirati Watcharachan Pitchayaponne Klunklin Wimrak Onchan The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand BMC Cancer Breast cancer Ki-67 Cut-off Subtype |
| title | The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand |
| title_full | The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand |
| title_fullStr | The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand |
| title_full_unstemmed | The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand |
| title_short | The association between Ki-67 expression and survival in breast cancer subtypes: a cross-sectional study of Ki-67 cut-point in northern Thailand |
| title_sort | association between ki 67 expression and survival in breast cancer subtypes a cross sectional study of ki 67 cut point in northern thailand |
| topic | Breast cancer Ki-67 Cut-off Subtype |
| url | https://doi.org/10.1186/s12885-025-13724-w |
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